Wishing Phil well …

950002-nitschke-to-fight-medical-board-suspensionThe Northern Territory News reports that veteran euthanasia campaigner Dr Philip Nitschke faces a five-day hearing before the Medical Board starting today. Nitschke’s arguments will include:

Mr Nitschke says suicide is a lawful activity and the appeal was a question of whether rational adults should have access to information to help them proceed.

I wrote quite a long article a couple of weeks ago about euthanasia and Phil Nitschke. Someone on that thread remarked that Nitschke gave them the creeps.

Other people have said similar things to me in the past. I don’t really understand why. Certainly Nitschke is an intense, determined and even obsessive personality. But the same would almost certainly be true of just about any crusader for any cause. You need to have those qualities to maintain focus on such a difficult issue, involving intense emotions and huge end of life questions, over such a long period of time.

As I made clear in my previous article, I don’t agree with every single aspect of Phil Nitschke’s position on euthanasia.  I certainly don’t agree that it should be lawful for any person, doctor or otherwise, to assist a person to commit suicide who has neither a terminal illness nor a chronic, incurable and painful medical condition. However, it needs to be kept in mind that Nitschke did not assist Nigel Brayley to commit suicide. He merely provided information about euthanasia options. It still raises difficult ethical issues about whether a doctor owes a duty of care to satisfy himself about a person’s state of mind before providing such information, and no doubt that is the principal issue that the Medical Board will be determining.

In that respect the Medical Board’s decision and reasoning will be very important for the future of euthanasia in this country. If the Board decides that a doctor does have a duty of care to satisfy himself about the state of mind of any euthanasia enquirer, that would effectively make it impossible for any one of us to access reliable medical information about euthanasia options without submitting ourselves to an invasive, distressing and deeply offensive full psychological assessment. In my view everyone (unless clearly suffering a significant mental illness) should have a right to such information, and doctors should have no right to suppress it.

With people today living longer and longer, these ethical dilemmas surrounding end of life decisions will inevitably become more frequent and more acute. We can’t keep fobbing them off and just leaving it to doctors’ disciplinary bodies to decide. Parliaments need to develop some intestinal fortitude, stop worrying about the reactions of a small minority of religious zealots, and enact appropriate legislation along the lines of the Northern Territory’s Rights of the Terminally Ill Act.

I regard Phil Nitschke as a great man and a modern day hero, and I wish him every success in his joust with the Medical Board.

About Ken Parish

Ken Parish is a legal academic, with research areas in public law (constitutional and administrative law), civil procedure and teaching & learning theory and practice. He has been a legal academic for almost 20 years. Before that he ran a legal practice in Darwin for 15 years and was a Member of the NT Legislative Assembly for almost 4 years in the early 1990s.
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I am still Not Trampis
I am still Not Trampis
7 years ago

He didn’t assist Brayley but merely provided information. This is a contradiction Ken.

A very blatant one in fact.

You regard him as a great man . Sorry I see him as an evil one.
The sooner this bloke is no longer a doctor the better.

steve from brisbane
7 years ago

Ken, it is of course the thing you “don’t agree with” that creeps people out about him.

Forget about him being a doctor, how would you feel about any person who had contact with one of your relatives enquiring about the best and least painful way to top themselves, and then (when the suicide happens) shrugs their shoulders and says “hey, don’t blame me – I was just providing information and who am I to recommend or suggest psychological help instead?”.

I would view any person who has done that has acted with no regard to ethics or common sense, let alone a doctor, who is supposed to have experience with helping people undergoing psychological pain, not just physical.

Of course he should not be allowed to continue to be a doctor. His death embracing career, and completely cavalier attitude as to why people may want to commit suicide, can continue in a “civilian” capacity.

I am still Not Trampis
I am still Not Trampis
7 years ago
Reply to  Ken Parish

No there isn’t. If you tell a person what they have to do then you are quite clearly assisting them to kill themself.

I’m not sure why you are even arguing with this.

steve from brisbane
7 years ago
Reply to  Ken Parish

Ken, I think you’re engaging in slippery slope arguments here of at least as great a magnitude as some on the anti-euthanasia side.

Your example of a lecture about diminished responsibility may well be of questionable ethics if it were being delivered to, say, a meeting organised for a local Hells Angels Club after a raid over a recent spate of bikie related murders. A lecture given to a public audience in which one bikie attends after seeing it advertised would be a different thing entirely.

The difference in this case is also that Bayley did not just attend an Exit lecture, but was in direct email communication with PN. I see from an Exit media release that Bayley wrote to PN:

“I am not ashamed by my decision to exit or the reasons for it, however I don’t honestly fit neatly under Exits charter of supporting a terminal medical illness however i am suffering and have been now for some 9 months now. I have sought medical and other forms of assistance but they are unable to help. All recognise and accept that my life will never be the same and that its only going to get worse and I am not prepared to risk my families financial security and happyness by continuing along this same path. I am 45 years old but have travelled and experienced more of this world than most people twice my age. I have a beautiful wife who is still young enough to move on and find happiness again and its this knowledge and my desire for this to happen that makes my decision so much more easier.”

Now, while I can imagine that Dr N may be happy to rely on the sentence about Bayley having sought “medical and other forms of assistance” as indicating that it wasn’t worth recommending he try something else, by the time you get to the last sentence (and earlier on), it just sounds so obviously like the typical rationalisation of the depressed (but physically healthy) – that they are contemplating suicide in order to not be a burden on a loved one, emotionally and financially.

The problem with PN is that he appears far, far too ready to routinely assume that a person has made a rational decision about suicide, and that this means the suicide is indeed justified (for want of a better word). But it is common knowledge that suicidal people suffering from entirely treatable depression routinely adopt a cloak of “rationality” for their decision.

The reality is, of course, that thousands of people, having received appropriate treatment, can see the problem with their former “rational” thinking, and are glad someone urged them to get the help that worked.

This is why so many people think PN’s judgement is so badly lacking, and to such a serious degree that it is not how a doctor should act.

If you have concerns that this is discussing his case in too much detail given his current tribunal hearings, feel free to delete.

steve from brisbane
7 years ago

By the way, I have also read how other euthanasia reform advocates have long seen his extreme views as counterproductive to the cause. I certainly can understand why. Am surprised you can’t see that.

Nicholas Gruen
Admin
Nicholas Gruen(@nicholas-gruen)
7 years ago

If I try to use what reason I have on these kinds of debates, I end up where Peter Singer is. I guess these were my views when I was a kid. If there’s no difference between the capabilities of someone with human form and some dumb animal, what’s the deal with them having more rights. It’s in the face of that that these days I back off and simply suspend judgement – either way I might say. It’s not something about which I feel very comfortable with strident views (though I can understand the stridency of those arguing for the right to die of those who are terminal and in great pain.)

My mum turned 92 ten days ago. In a home.

About 18 months ago, I’d visit her and, though she had bad dementia, could not hold any kind of conversation or really utter a sentence that made sense, her eyes lit up with pleasure and love when she saw me on my way to visit her across the room.

Today she doesn’t recognise me. She simply exists. She sleeps most of the time. When I last saw her, she’d fallen out of bed (a safe thing to do as the bed is lowered to the floor). She was sleeping and was cradling a shoe in both hands – stretched out prayer-like – and occasionally moving it to her mouth.

What am I to make of this situation? I’m afraid I can’t make anything much of it. I find myself slipping into thinking about her in the past tense. She exists as a physical simulacrum of the person she once was. Beyond that, I have no idea how I should think of her.

I can’t help thinking that we’re all doing what we’re doing – the carers caring for her physical needs and me and family members paying for the home and visiting her – out of a kind of timidity. It doesn’t really make much sense to do these things. I can’t claim omniscience about this, so I could be wrong, but there is no sign that it does her any good. In a negative sense of course we care, or try to care as best we can for her physical needs because she can feel pain and we can alleviate that. Beyond that, those who visit her do it our of sentiment – rather than any clear understanding of her needs, and because we don’t’ want to feel badly about ourselves.

And as for keeping her alive? Well we don’t want to ‘play God’ as we say. She’s a simulacrum of who she was and we’re responding in kind with a simulacrum of care – which is now care for a body, for a memory. I have no clear views that there is a better way to behave, but I find it hard to have strong views about what the right thing to do is.

Cris Bennett
Cris Bennett
7 years ago

I understand why people who’ve only seen Nitschke in brief news grabs might find him creepy. He’s a pugnacious character, which in combination with an apparently brisk promotion of the right to choose death, appears cold, if not downright undoctorly. But encountered in person for a longer period, it’s quite obvious that he’s entirely aware of the delicate gravity of an individual’s death. He is by nature more of of a fighter (previously for aboriginal rights) than philosopher, so perhaps oversimplifies the issues, but doers like him are always needed somewhere in the social change mix.

I agree with your conclusion, Ken. When a conservative authorities diverge so far from evolving vernacular ethical beliefs and are determined to block change, it takes real courage for someone with a highly contingent professional standing to face up to them as Nitschke is doing.

Paul Frijters
Paul Frijters
7 years ago
Reply to  Cris Bennett

yes, agreed as well.

The inability of parliaments to discuss such things rationally, and thus leaving it to doctors and nurses to make these decisions implicitly rather than explicitly, is a bit of a puzzle. As if by not discussing painful things they wont happen and we can all pretend life goes on forever in lala-land. This head-in-the-sand attitude is unfair on the doctors and nurses who are then forced to make the tough decisions and live in some legal limbo land.

Sancho
Sancho
7 years ago

What choice does Nitschke have in trying to maintain plausible deniability for his assistance with euthanasia? It’s quite obvious that he would actively be helping people to manage their end-of-life process if he were able, but that’s simply illegal, so he has to resort this crass legalism about whether providing information is the same as active involvement.

This discussion seems so old-fashioned, as though information on suicide is something hidden and known only to experts, instead of the focus of a thousand websites and discussion boards. Nitschke is one of the more sensible voices on this matter, advocating the option of effective euthanasia for the terminally ill, rather than untreated depressives with web handles guessing about plastic bags and Panadol for sad adolescents.

I am still Not Trampis
I am still Not Trampis
7 years ago

Without Nitschke Brayley would have no idea of how to commit suicide and succeed.

Case closed.

I am still Not Trampis
I am still Not Trampis
7 years ago

Ken,

I do not have to I know what suicide is and what it entails for friends and family.

It is you that is hiding behind words. It isn’t your finest hour.

Marks
Marks
7 years ago

I do too, having had a friend of many years commit suicide.

Alone, because he could not have his friends around him.

In extreme pain, because the only meds that could ease it, so debilitated him.

A miserable death forced on him by religious bigots.

He could not make the choice of leaving with dignity because the self righteous judgemental turds of this world would not allow it.

His wife and the rest of us had to remain in ignorance, lest we be subjected to a police inquisition, and so she had to come home to find the body.

Frankly, it would have been better for everyone concerned had my friend contacted Dr Nitschke so that it would at least have been less messy for my friend’s wife.

Perhaps, just like with other social changes, those who wish them need to make more public statements and actions so that the uncaring or the unctuous can’t ignore them.

Sancho
Sancho
7 years ago

Exactly. The world is full of people contemplating suicide or ruminating on death either seriously or romantically, and they’re not at all shy about sharing their thoughts across the internet.

Scrutinising Nitschke’s ethics and motivations is completely valid, but to suggest that he is some purveyor of obscure and complex information on suicide is breathtakingly ignorant.

I am still Not Trampis
I am still Not Trampis
7 years ago

So Sanchez you believe Brayley had all the information to kill himself whilst in the prime of his life without Nitschke’s help.
So presumably he was asking him how to make a cup of tea?
At the very least Nitschke should have done a due diligence on the man and he has readily admitted in the media he didn’t. He claimed Brayley was of a sound mind and making a rational decision!

I am still Not Trampis
I am still Not Trampis
7 years ago

whoopsy Sancho definitely not Sanchez

steve from brisbane
7 years ago

With all the enthusiasm for legal euthanasia, I might add a side observation.

I doubt it’s going to help much with the expected rise in the number of elderly suffering dementia. My own mother, who died earlier this year, used to say from her 60’s what a lot of aging people do – that it would be good if she could just take a pill to put her to permanent sleep if she felt she was becoming, or about to become, a burden. But she went on to live independently, and happily, until about age 86, when gradual signs of coming dementia started appearing, which worsened over the space of a year or two, until she had to go into aged care. All but one or two of the residents there were obviously not in any state to be making sound judgement about euthanasia.

But the thing is, once we felt certain that it was dementia on its way (due to some clearly odd behaviour and things said, and medical assessment done) I don’t think anyone could feel confident that she was then able to make a very rational decision about ending her life. There may be a period in which there is awareness that they are “losing it”, but gee, its hard to know whether that is just really part of general confusion, or that it is really their rational part of their mind seeing what’s going on.

So for the one of the biggest concerns that people have, I don’t see legal euthanasia helping much; at least if you are of the view that would not be a desirable system to allow relatives to make the call as to when the pill is to be administered to a conscious person.

I am still Not Trampis
I am still Not Trampis
7 years ago
Reply to  Ken Parish

so Ken has the right to impose his views on everybody but others are not allowed.

Say no more

I am still Not Trampis
I am still Not Trampis
7 years ago

That’s al right Ken I am ignoring your illogical comments anyway but impose your views at will

steve from brisbane
7 years ago
Reply to  Ken Parish

I know there are some people (I would think, more likely, those with relatively early onset Alzheimers) who understand the diagnosis and what lies ahead. In my mother’s case, where it was late onset and a case of the family becoming increasingly concerned about her behaviour, it was never clear that there insight on her part; just increasing confusion, and a resistance to receiving assistance via medication or home care.

I think for many cases, the mere fact that there is some dementia would give a lot of children discomfit as to whether their parent was thinking clearly at the time they decided to end it.

This is not being put as a compelling reason to be against legalised euthanasia per se; just a caution against people thinking that legalising it would necessarily reduce old age related suffering by a large amount in the general population.

steve from brisbane
7 years ago

Ken, I saw Barry Cohen on 7.30 last night, and he certainly fitted within the category of a person with a diagnosis of early dementia who still had clear insight of his condition and future prospects.

But nonetheless, his capacities at this time seemed so strong that I thought his family would likely very much regret his opting to take euthanasia now. That’s the problem here – until people have advanced far enough down the track of dementia, euthanasia seems premature. Once they have reached the point where it appears to everyone it isn’t premature, they have lost capacity for rational decision, and letting the relatives make the call as to the point at which it can be administered could be very messy in many respects.

Peter WARWICK
Peter WARWICK
7 years ago

My mother died some years ago of ovarian cancer. The cancer was fairly aggressive, but she was on morphine and experienced little/ no pain.

In her last months, she sat me bedside and said that if the good nurses who administer the morphine (administered by 2 nurses, 1 as witness) made a silly arithmetic error and moved the decimal point 1 or 2 places to the right, tell them not to worry. She was lucid and was aware of what she had said.

I mentioned the conversation to her oncologist, who told me that he receives 3 of these request every day. He also said he was not totally adverse to the requests. The hospital was a veterans hospital and the patients were there to die. The vast majority wanted a painless, quick death rather than a prolonged and wretched affair. Almost all patients had prepared themselves, some saying they had made peace with their Maker and themselves.

But the oncologist he said he was at the top of his profession and could not risk detection concerning assistance with euthanasia. He did not want to go home and tell his family and colleagues he had been charged with murder.

He advised that the nurses sometimes, with a wink and a nod, do make arithmetic mistakes, and he was was aware of that practice without direct knowledge.

But generally the whole subject was not spoken about in the hospital for fear of listening devices.

john Walker
john Walker(@johnrwalker)
7 years ago

Steve my mother was a trained nurse , she used to talk a lot about the fact that people with dementia in care, are regularly given the vaccine against pneumonia. Pneumonia was once a common cause of death in the old, Mum used to say that nurses used to call pneumonia ‘the old persons friend’. It would be good If we did less of mindlessly dragging out, dying .

Hildy
Hildy
7 years ago
Reply to  john Walker

Captain of the men of death, the old man’s friend. Dying from pneumonia seems to be a lot more pleasant than dying of other things.

What palliative care can’t do is grant dying with dignity. If I discover that I have a glioblastoma multiforme, there will be a day that I invite my friends and family over to say goodbye, then wander off into the bushes with some lignocaine and a sharp knife. I have no desire to lose my personality and my mind to an intracranial malignancy, to linger on for months after that.

Back on topic: AHPRA has precedent for viewing statements made outside a doctor-patient relationship as being potentially unsatisfactory professional conduct or professional misconduct (see Jereth Kok’s facebook comments). I think Dr N should be admonished, conditions placed on his registration, but not struck off.

I am still Not Trampis
I am still Not Trampis
7 years ago

yep, been there done that.

Well said

I am still Not Trampis
I am still Not Trampis
7 years ago

Dying with dignity had nothing to do with this, Brayley was in the prime of his life.

The is the major point Ken keeps on evading. It was suicide not dying with dignity

Nicholas Gruen
Admin
Nicholas Gruen(@nicholas-gruen)
7 years ago

If I am to apply my reason to these questions, I end up not far from where Peter Singer is. It’s in the light of that that I pull back. I’m not God and don’t feel comfortable having strong views about any of this.

As a practical matter, my mother just turned 92 and is completely incoherent with dementia. About 18 months ago, she was similar, but when I went to visit her, her eyes lit up with pleasure and recognition.

Today she doesn’t have the slightest idea who I am. She’s not in pain, and so it’s not particularly cruel keeping her alive. But I can’t help thinking that the only reason we’re all keeping her alive is that we’re all morally scared of ‘playing God’ as they say – of taking the ultimate responsibility of life or death over another person’s life. Thing is I often catch myself reaching for the past tense in speaking of her. As a person, as the person who loved me, she’s well and truly gone – and present as a physical simulacrum.

Hildy
Hildy
7 years ago
Reply to  Nicholas Gruen

Nicholas,

Modern medicine is playing God. We can cure diseases now that would have been a death sentence 100, 50, or even 20 years ago. So I don’t think that my making a difficult decision, you are playing God.

I don’t know if you are the ‘person responsible’ for your mother, but if you are, the next time you are asked to consent to a treatment, perhaps you should ask the doctor what the goals of treatment are. I often wonder what my colleagues are thinking when they put 95yo demented nursing home residents on medications that will reduce the risk of stroke or heart attack by 5% in the next year. I would think that a heart attack is a kindness in that situation.